Accuracy of Mini-Implant Placement Using a Computer-Aided Designed Surgical Guide, with Information of Intraoral Scan and the Use of a Cone-Beam CT

Abstract

Background: The purpose of the study was to investigate the accuracy of mini-implant placement with the use of a computer designed surgical guide derived by intraoral scanning alongside Cone-Beam Computed Tomography (CBCT) or the use of a 2D radiograph. Methods: Thirty-five mini-implants (Aarhus® System: n = 20, Ø: 1.5 mm and AbsoAnchor®: n = 15, Ø: 1.3–1.4 mm) were placed in the maxilla and mandible of 15 orthodontic patients for anchorage purposes in cases where a CBCT was needed due to impacted teeth or for safety reasons. All were placed with the help of a computer designed surgical guide. One implant became loose and was excluded from the study. For 18 mini-implants (study group), CBCT and intraoral scanning were used for guide design, while for 16 (control group) only intraoral scanning and panoramic imaging information were used. Mini-implant position was recorded by angular and linear measurements on digital models created by combining Digital Imaging and Communications in Medicine (DICOM) and stereolithography (.stl) files. Accuracy in positioning was determined by comparing corresponding measurements for virtual and real positioned mini-implants on digital models before and after operation. The results were statistically analyzed with t-tests and the Mann-Whitney test. Results: No significant statistical differences were found for pre- and post-operational angular measurements in the study group, while significant statistical differences occurred on the same measurements for the control group (coronal angle 13.6° pre-op and 22.7° post-op, p-value = 0.002, axial angle 13.4° pre-op and 15.9° post-op, p-value = 0.034). Linear measurements pre- and post-operational for either group presented no significant statistical differences. Conclusions: A 3D designed and manufactured surgical guide with information concerning CBCT and intraoral scanning ensures accuracy on mini-implant placement while design of the guide without the use of a CBCT is less accurate, especially on inclination of the implant.